tag:theconversation.com,2011:/institutions/university-of-massachusetts-medical-school-2215/articlesThe University of Massachusetts Medical School2018-11-28T11:42:19Ztag:theconversation.com,2011:article/1073992018-11-28T11:42:19Z2018-11-28T11:42:19ZForget lanes – we all need to head together toward preventing firearm injury<p>Many of us working in the “<a href="https://gunsensevoter.org/about/">Gun Sense</a>” field – that is, finding a middle ground position to advance firearm safety and reduce preventable injury in our patients – had an “a-ha” moment that led us to toil in these fields. </p>
<p>Mine was on Nov. 2, 1981, when my friend and co-resident <a href="https://www.woodfdn.org">Dr. John C. Wood II</a> was shot right in front of our hospital emergency room at Columbia Presbyterian Hospital in Washington Heights, New York City.</p>
<p>I have taken care of many gunshot wound victims since then, but none so difficult emotionally as this one. I participated in cracking my friend’s chest to start open cardiac massage and saw his heart devoid of blood from a through-and-through gunshot wound into his heart with a Saturday night special. </p>
<p>The survivability of a cardiac gunshot wound like this is close to zero, even though he was minutes away from the ER. He was in the OR and placed on cardiac bypass within 10 minutes of arrival. But his pupils were fixed and dilated and he had exsanguinated, or bled out, into his chest cavity. He did not survive despite our best efforts. It was an event that rocked Columbia and all who knew John, a fully boarded pediatrics-turned-surgical resident, a world-class Juilliard-trained French horn player and former Columbia rugby team captain. </p>
<p>The urgency of the firearm violence issue facing our country was heightened this past week when nine people were killed in three separate mass shootings over an 18-hour period in the U.S. In the past month, there have been attacks at places of worship, yoga studios and hospitals. Add these to the shootings in schools and in movie theaters and the <a href="https://www.apa.org/helpcenter/mass-shooting.aspx">tremendous sense of unease</a> our citizenry is experiencing is completely understandable. </p>
<p>As physicians and surgeons on the front lines, many of my colleagues and I feel that it is no longer acceptable to treat this problem like our trauma team is a MASH unit. We have an obligation and an opportunity to reach out and speak out, and my hope is the country is listening. Because this is indeed our lane.</p>
<h2>Watching the violence grow</h2>
<p>My training took me to other cities, and everywhere the tragedy of firearm injury seemed to follow. I knew after that night in November ‘81 I could no longer practice in New York City, but I could not escape the parade of firearm tragedies. Children shot accidentally. Teens shot in gang wars. Teens and elders shooting themselves in impulsive moments of despair, yielding nearly 100 percent completion of their suicide task. </p>
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<img alt="" src="https://images.theconversation.com/files/246745/original/file-20181121-161618-1dw1igf.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/246745/original/file-20181121-161618-1dw1igf.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=409&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/246745/original/file-20181121-161618-1dw1igf.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=409&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/246745/original/file-20181121-161618-1dw1igf.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=409&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/246745/original/file-20181121-161618-1dw1igf.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=513&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/246745/original/file-20181121-161618-1dw1igf.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=513&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/246745/original/file-20181121-161618-1dw1igf.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=513&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Jim Brady, Ronald Reagan’s press secretary, was paralyzed after being shot in the March 1981 assassination attempt against the president. Brady died Aug. 4, 2014, and his death was ruled a homicide.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/YE-Deaths/d0f8c9f81e8b434cbb5bfaa036837917/19/0">Evan Vucci/AP Photo</a></span>
</figcaption>
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<p>Gun violence increasingly became my focus when I heard Sarah Brady explain the concept of limiting access to lethal means. Sarah is the wife of <a href="https://www.nbcnews.com/nightly-news/reagan-press-secretary-jim-bradys-death-ruled-homicide-n176521">Jim Brady</a>, Ronald Reagan’s press secretary shot in the 1981 presidential assassination attempt. Brady spent the rest of his life partially paralyzed. He died in 2014, and the medical examiner ruled his death a homicide. </p>
<p>The Brady approach to gun control is limiting access. It is based on the premise that we might not be able to deal with the root causes of the violence – racism, poverty, mental illness – but that we could perhaps deal with the vector of violence that elevates all these factors into lethality – access to firearms. This is the philosophy behind the <a href="http://www.bradycampaign.org">Brady Campaign</a>, which aims to limit gun violence in the U.S. I began to wonder what I as an individual trauma surgeon could do to make a difference. </p>
<h2>Looking for answers</h2>
<p>In the 1990s, I was working in Pittsburgh as a pediatric trauma surgeon. A gang turf war over control of the crack cocaine trade broke out between the Bloods and the Crips. Both sides were heavily armed. As the body count rose on the north side of Pittsburgh where I was working, legislators tried to help by establishing a mandatory sentence for anyone in possession of a firearm when arrested for drug trafficking. </p>
<p>This caused the dealers to push the age of the drug runners to preteens and young teens, and they were equally armed. Our pediatric gunshot-wound patient victim numbers soared. When an 11-year-old was shot with an AK-47 in front of the mayor’s house, suddenly the city responded. Pittsburgh held community meetings. As director of a Robert Wood Johnson Injury Prevention Program, I was selected to represent the Allegheny General Hospital. The community disparaged our hospital as being insensitive and uncaring. Many believed we were “profiting” from the carnage and just sending the patients back out into the street to face more mayhem even if they had survived. </p>
<p>Our hospital encouraged my practice partner, Dr. Matt Masiello, and me to do something. We were both transplanted New Yorkers in the ‘Burgh, and we had heard about a new kind of gun buyback program in Washington Heights where a carpet store owner, <a href="https://www.nytimes.com/1993/12/30/nyregion/carpet-man-fulfills-promise-with-guns-for-toys-program-fernando-mateo-succeeds.html">Fernando Mateo</a>, had emptied his inventory in exchange for locals bringing in their firearms. Previously, gun buybacks had only offered cash for the weapons. We decided to build a version of the program exchanging the guns for gift certificates to local merchants rather than actual merchandise. We collected 1,400 weapons that first year in 1994 and about 10,000 since then. </p>
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<img alt="" src="https://images.theconversation.com/files/246746/original/file-20181121-161609-6zaw0x.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/246746/original/file-20181121-161609-6zaw0x.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=393&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/246746/original/file-20181121-161609-6zaw0x.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=393&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/246746/original/file-20181121-161609-6zaw0x.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=393&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/246746/original/file-20181121-161609-6zaw0x.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=494&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/246746/original/file-20181121-161609-6zaw0x.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=494&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/246746/original/file-20181121-161609-6zaw0x.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=494&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A Miami detective registers a Magnum .357 in a gun buyback event in March 2016.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Daily-Life-Florida/53f5a92e08514c16babcbdf6d086d900/10/0">Lynne Sladky/AP Photo</a></span>
</figcaption>
</figure>
<p>The buyback program has become much more than just a way to give the patrons the ability to rid their homes of unwanted or unsecured weapons. We built a public information blitz about the <a href="https://journals.lww.com/jtrauma/Abstract/2011/11002/Goods_for_Guns_The_Use_of_a_Gun_Buyback_as_an.10.aspx">responsibility that goes along with the right</a> to own a firearm, and we built awareness of the increased risk of suicide, homicide, femicide, accidental shooting, or breaking and entering for the purpose of stealing a firearm. </p>
<p>We have now reproduced the program in a number of cities across the U.S. In my hometown of Worcester, Massachusetts, working out of the UMass Memorial Medical Center, our multi-pronged approach to gun safety education coupled with the gun buyback has given us the distinction of having the lowest-penetrating trauma rate in New England.</p>
<p>In calendar year 2017, we had zero firearm fatalities, down from five the year before. </p>
<p>This was an astounding number, in view of national stats showing a rise from 33,000 deaths in 2010 to 38,000 in 2018. We faculty at the University of Massachusetts have built a curriculum for students at our medical school to empower doctors to ask the right questions in the proper way. </p>
<p>I am truly excited about the response my fellow physicians have demonstrated in their reaction to the National Rifle Association’s “<a href="https://www.cnn.com/2018/11/19/health/nra-stay-in-your-lane-physicians-study/index.html">stay in your lane</a>” comments.</p>
<p>The NRA has already tried and failed to gag doctors in Florida from talking with their patients about gun safety.</p>
<p>In 2011, it backed a bill ultimately passed by the Florida legislature that would have forbidden doctors from asking patients about gun ownership or gun storage unless the doctor had a specific reason to do so. Doctors in violation <a href="https://www.npr.org/sections/thetwo-way/2017/02/17/515764335/court-strikes-down-florida-law-barring-doctors-from-discussing-guns-with-patient">could have been punished</a> by loss of license and up to a US$10,000 fine. </p>
<p>“Physicians interrogating and lecturing parents and children about guns is not about gun safety,” read a <a href="https://www.npr.org/sections/thetwo-way/2017/02/17/515764335/court-strikes-down-florida-law-barring-doctors-from-discussing-guns-with-patient">letter from the NRA</a> in support of the bill. “It is a political agenda to ban guns. Parents do not take their children to physicians for a political lecture against the ownership of firearms, they go there for medical care.”</p>
<p>Though it took six years to do so, the parts of the law that gagged doctors were <a href="https://www.npr.org/sections/thetwo-way/2017/02/17/515764335/court-strikes-down-florida-law-barring-doctors-from-discussing-guns-with-patient">overturned by the 11th Circuit Court of Appeals</a> in February 2017. </p>
<p>And now, even more than in previous years, doctors are saying they have seen enough – actually, way too much. </p>
<p>Now the awakening of the M.D.s gives me a sense of encouragement and hope that we as a profession can lead our country away from the intransigent position in which nothing gets done. Gun buyback is a middle-ground Gun Sense position that can rally a community around the cause that I have been fighting for since that dark day in November 1981. I hope other municipalities will join us, as <a href="https://www.researchgate.net/publication/316569711_Are_Goods_for_Guns_Good_for_the_Community_An_Update_of_a_Community_Gun_Buyback_Program">these programs do work</a>.</p><img src="https://counter.theconversation.com/content/107399/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Hirsh is the medical consultant for the John C. Wood II charitable foundation.</span></em></p>In response to the NRA telling doctors to 'stay in their lane' on gun control, doctors loudly and clearly came back with this response: This is our lane. A surgeon explains their concern and urgency.Michael Hirsh, Professor of Surgery and Pediatrics, University of Massachusetts Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/999822018-07-27T10:43:24Z2018-07-27T10:43:24ZWho chooses abortion? More women than you might think<p>The abortion debate is at the center of U.S. political dialogue. As of June 2018, 49 percent of Americans <a href="https://news.gallup.com/poll/1576/abortion.aspx">consider themselves pro-choice</a>, while 45 percent consider themselves pro-life. Voices from both sides flood social media feeds, while newspapers, radio and television programs frequently cover the topic. </p>
<p>Since 2011, politicians have enacted <a href="https://www.guttmacher.org/article/2018/01/policy-trends-states-2017">400 pieces of legislation</a> restricting this medical procedure. </p>
<p>One important group’s voice is often absent in this heated debate: the women who choose abortion. While <a href="http://doi.org/10.2105/AJPH.2017.304042">1 in 4 women</a> will undergo abortion in her lifetime, stigma keeps their stories untold. As an obstetrician/gynecologist who provides full spectrum reproductive health care, including abortion, I hear these stories daily. </p>
<h2>Unintended pregnancy</h2>
<p>In 2011, nearly half of pregnancies in the U.S. <a href="https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states">were unintended</a>. This reflects <a href="https://www.guttmacher.org/report/moving-forward-family-planning-era-health-reform">a 6 percent drop in unintended pregnancies</a> since 2008, <a href="http://doi.org/10.1056/NEJMsa1506575">largely due to</a> <a href="https://www.hhs.gov/opa/title-x-family-planning/index.html">Title X</a> family planning programs and easier access to birth control. </p>
<p>One of my patients is a working mother of two small children. She came to see me when her youngest was five months old. She was breastfeeding and did not think she could become pregnant. She couldn’t afford childcare for a third child, and her family depended on her salary to survive.</p>
<p><a href="https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states">Unintended pregnancy</a> remains most common among poor women, women of color and women without a high school education. Women living in poverty have a rate of unintended pregnancy five times higher than those with middle or high incomes. Black women are twice as likely to have an unintended pregnancy as white women. </p>
<p>Barriers to birth control play a major role. Among women with unintended pregnancies, 54 percent were using no birth control. Another 41 percent were inconsistently using birth control at the time of conception. </p>
<p>Forty-two percent of women with unintended pregnancy choose to end their pregnancies. </p>
<h2>The women who choose abortion</h2>
<p>Abortion is a routine part of reproductive health care. Approximately 25 percent of women in the U.S. <a href="http://doi.org/10.2105/AJPH.2017.304042">will undergo an abortion</a> before the age of 45. The Guttmacher Institute, a research and policy institute in New York City, has been tracking these data for the last 50 years. </p>
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<p>American women have abortions with similar frequency <a href="https://www.guttmacher.org/report/abortion-worldwide-2017">to women living in other developed nations</a>. The bulk of abortion patients <a href="https://www.guttmacher.org/fact-sheet/induced-abortion-united-states">are in their 20s</a>. </p>
<p>Women of all races and ethnicities choose abortion. In 2014, 39 percent of abortion patients were white, 28 percent were black and 25 percent were Latina. Similarly, women of all religious affiliations choose to end their pregnancies. </p>
<p>Most of these women understand what it means to parent a child. More than half of abortion patients in 2014 were already mothers. </p>
<p>Poor women account for the majority of abortion patients. Fifty-three percent of women pay out-of-pocket for their abortion. The rest use private or state-funded insurance plans. </p>
<p>Women choose abortion <a href="https://www.guttmacher.org/journals/psrh/2005/reasons-us-women-have-abortions-quantitative-and-qualitative-perspectives">for multiple reasons</a>. The most common reason cited is that pregnancy would interfere with education, work or ability to care of dependents. </p>
<p>Financial stress also plays a major role in women’s decision making. Seventy-three percent of women reported that they could not afford a baby at the time. Nearly half cited relationship difficulties or wanting to avoid single motherhood. More than a third of women felt their families were complete. </p>
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<p>Twelve percent chose abortion due to their own health problems. For example, one of my patients and her husband were thrilled to find out she was pregnant for the first time. Then she received the diagnosis of metastatic breast cancer. She had to choose between lifesaving chemotherapy and radiation or her pregnancy.</p>
<h2>Safety of abortion</h2>
<p>Nine in 10 women who receive abortions undergo abortion in the first trimester. Only 1.3 percent of abortions happen with pregnancies past 20 weeks gestation. </p>
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<p>When performed legally by skilled practitioners, abortion is <a href="https://www.guttmacher.org/fact-sheet/induced-abortion-united-states">a safe medical procedure</a> with a low complication rate. The risk of major complications – such as hospitalization, infection, blood transfusion or surgery – in first-trimester procedures is less than 0.5 percent. <a href="http://doi.org/10.1097/01.AOG.0000431056.79334.cc">The risk of dying in childbirth</a> is 14 times higher than the risk of dying from safe abortion. </p>
<p><a href="http://doi.org/10.17226/24950">Studies show</a> that abortion is not linked to long-term health complications, including breast cancer, infertility, miscarriage or psychiatric disorders. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25437742">The American College of Obstetricians and Gynecologists</a>, the nation’s leading professional organization of obstetricians and gynecologists, has reaffirmed the safety of abortion. </p>
<p>Conversely, the negative impacts from abortion restrictions are well-documented. <a href="http://doi.org/10.2105/AJPH.2017.304247">Women unable to obtain abortions</a> are more likely live in poverty or depend on cash assistance, and less likely to work full-time. </p>
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<p>Furthermore, banning abortion is ineffective at reducing abortion. <a href="https://www.guttmacher.org/report/abortion-worldwide-2017">Countries with the most restrictive abortion policies</a> have higher rates of abortion, the majority of which are unsafe, performed by untrained individuals without proper equipment or facilities. </p>
<p>In my view, women need safe access to abortion as part of their health care.</p><img src="https://counter.theconversation.com/content/99982/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Luu D Ireland is affiliated with Physicians for Reproductive Health.</span></em></p>One in 4 US women receives an abortion sometime in her life. Who are the women who choose to end their pregnancies?Luu D. Ireland, Assistant Professor of Obstetrics and Gynecology, University of Massachusetts Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1000582018-07-18T18:23:20Z2018-07-18T18:23:20ZNew treatment in the works for disfiguring skin disease, vitiligo<figure><img src="https://images.theconversation.com/files/227851/original/file-20180716-44082-1mly053.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">This African woman suffers from an autoimmune disease called vitiligo which causes the loss of skin pigment.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-african-girl-studio-skin-problems-1017272866">By andreonegin/shutterstock.com</a></span></figcaption></figure><p>In many parts of the world there is great shame and stigma tied to vitiligo, an autoimmune disease of the skin that causes disfiguring white spots, which can appear anywhere on the body. In some societies, individuals with vitiligo, and even their family members, are shunned and excluded from arranged marriages. The rejection is so crippling that one person suffering from the disease even requested an <a href="http://doi.org/10.1016/S0140-6736(14)60763-7">amputation of his forearm affected by vitiligo</a> because he could marry with only one arm, but could not with vitiligo.</p>
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<a href="https://images.theconversation.com/files/228080/original/file-20180717-44088-1899kjq.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/228080/original/file-20180717-44088-1899kjq.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip"></a>
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<span class="caption">John Harris and his team engineered mice that developed vitiligo so that they can test new treatments for the disease. Depigmentation is visible on the mouse’s ears, feet, and tail.</span>
<span class="attribution"><span class="source">John Harris</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>I am a physician-scientist and director of the <a href="https://www.umassmed.edu/vitiligo/">Vitiligo Clinic and Research Center</a> at the University of Massachusetts Medical School and I’ve witnessed my patients’ suffering and depression. Some are so ashamed of how they look; they refuse to leave their homes in daylight, they quit their jobs, and they lose relationships. Some of those afflicted with vitiligo have committed suicide. </p>
<p>I began studying vitiligo in 2008 because this devastating condition affects about one percent of all people – over 75 million worldwide – and patients deserve better treatments. In a recent report published in Science Translational Medicine <a href="http://doi.org/10.1126/scitranslmed.aam7710">we describe a new therapy</a> that is showing particular promise in mice with this disease.</p>
<h2>Your skin has a memory</h2>
<p>Existing treatments such as topical steroids and light therapy, which are used “off-label” because they have not been FDA-approved to treat vitiligo, can be effective for patients. These treatments reverse the disease by stimulating brown spots to appear around hair follicles within the affected white patches of skin. As these brown spots increase in number and size they merge until the white patch is replaced with normal skin color. </p>
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<a href="https://images.theconversation.com/files/228079/original/file-20180717-44091-1ody9jz.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/228079/original/file-20180717-44091-1ody9jz.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip"></a>
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<span class="caption">Current treatments for vitiligo involve stimulating pigment cell regrowth from the hair follicles, which results in brown dots around the hairs. As these brown dots grow and merge, the white patches disappear.</span>
<span class="attribution"><span class="source">John Harris</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>This takes between one and two years, depending on the location of the body being treated. However, in most cases the white spots reappear at the same location, often within just one year after stopping the treatments. This recurrence can be just as devastating as when the white patches first appeared.</p>
<p>We wanted to find out why these spots reappear. Our research team suspected that “memory” forms within the skin when the white spots first appear, so that the spots “know” where to return when treatments are stopped. Working separately, we and three other laboratories led by <a href="https://ki.se/en/people/liveid">Liv Eidsmo</a>, <a href="https://geiselmed.dartmouth.edu/faculty/facultydb/view.php/?uid=2872">Mary Jo Turk</a>, and <a href="http://u1035-inserm.fr/en/profile/julien-seneschal">Julien Seneschal</a> searched for the source of this memory in the skin. </p>
<p>These <a href="http://doi.org/10.1016/j.immuni.2017.01.009">three </a><a href="http://doi.org/10.1126/sciimmunol.aam6346">other</a> <a href="http://doi.org/10.1016/j.jid.2017.08.038">labs</a> first found cells in vitiligo skin from mice or humans that looked a lot like the memory cells that protect the skin from a second exposure to a viral infection, suggesting that the body “thinks” it is fighting a viral infection when it “misfires” at the patient’s normal cells, killing the pigment-producing cells in the skin called melanocytes and causing vitiligo. These cells are called “resident memory T cells.” </p>
<p>Because immune responses to a virus act in a similar way to immune responses that cause autoimmune diseases, it seemed reasonable that these cells might also be the source of this remaining disease memory in the skin. </p>
<h2>Disease memory can be erased with new treatment</h2>
<p>We used a technique called <a href="http://doi.org/10.1016/j.jaad.2016.12.021">skin blistering</a> to isolate skin and skin fluid directly from the spots of my vitiligo patients and isolate the disease-causing memory cells so we could analyze them more closely. Similar to the other labs, we also found the virus-like memory cells, and we were able to also determine that these cells specifically targeted the melanocytes. We hypothesized that if we could remove these memory cells from the skin using a new treatment, then treatments to repigment the skin would be long-lasting and possibly permanent. </p>
<p>We then tested our hypothesis on mice we specifically engineered to develop vitiligo. Like humans, mice also have memory T-cells so we looked for their “Achilles heel” to see if we could knock them out without harming other cells. Our team figured out that the vitiligo-causing memory cells require a special protein called “IL-15” to survive. We injected the vitiligo mice with an antibody that blocks the IL-15 protein from interacting with the memory cells.</p>
<p>After just a few weeks we <a href="http://doi.org/10.1126/scitranslmed.aam7710">discovered</a> that the treatment wiped out the memory cells from the mouse skin, allowing the brown pigment to return in a spotty pattern, just as we see in patients who respond to therapy. Importantly, just two weeks of antibody treatments caused repigmentation that lasted for months, suggesting this strategy, unlike existing treatments, might provide long-term benefit for vitiligo patients. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/228081/original/file-20180717-44079-oa5rwf.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/228081/original/file-20180717-44079-oa5rwf.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip"></a>
<figcaption>
<span class="caption">On the left is a mouse with vitiligo that received control antibody. After 12 weeks the tail remained white, without pigment. The mouse on the right also had vitiligo but was treated with the antibody to block IL-15 signaling. Twelve weeks later the tail was largely repigmented.</span>
<span class="attribution"><span class="source">John Harris</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Human clinical trials may begin next summer</h2>
<p>During our study we also found that the vitiligo-causing memory T-cells in both mouse and human skin seem to require IL-15 more than other types of T cells – which means they are more sensitive to levels of this protein. This is important because it means we might be able to selectively remove the vitiligo-causing cells without harming other important immune cells too. In the treated mice, the vitiligo-causing cells became undetectable, but the other T-cells responsible for fighting infection remained unharmed and present, suggesting that our antibody therapy might be safer for the immune system than first thought. </p>
<p>Based on these results, we are working with the National Institutes of Health-funded <a href="https://www.immunetolerance.org">Immune Tolerance Network</a> (ITN) to develop a <a href="https://www.umassmed.edu/vitiligo/">clinical trial</a> to test this antibody treatment in human patients. We are hopeful that we can begin recruiting patients next summer. </p>
<p>Although this antibody drug has only been proven to work in mice with vitiligo, we are excited to <a href="https://www.umassmed.edu/vitiligo/">test it in humans</a> because it could represent a significant advance over existing treatments. The partnership with the ITN will allow us not only to test whether it works for vitiligo patients, but also how it works. This will help us know when and in whom to use this new therapy.</p><img src="https://counter.theconversation.com/content/100058/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Harris receives funding from the National Institutes of Health (NIH).</span></em></p>An autoimmune disease called vitiligo causes white spots to appear on the body, in some cases completely erasing an individual's pigmentation. But a new therapy is on the horizon.John Harris, Associate Professor of Dermatology, University of Massachusetts Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/942382018-06-06T10:37:34Z2018-06-06T10:37:34ZWhy pregnant women with depression often slip through the cracks<figure><img src="https://images.theconversation.com/files/221011/original/file-20180530-120508-oetswn.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">One in 7 women suffer depression around pregnancy.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-hand-his-mother-window-601418018?src=rPcLobTmk2VA_To5PpingQ-1-6">Lopolo/shutterstock.com</a></span></figcaption></figure><p>Judy’s first pregnancy was planned, and she was looking forward to having a baby. Yet, halfway through the pregnancy, something changed. She began to feel down and bad about herself. She had less energy and struggled to concentrate. Thinking this was a normal part of pregnancy, she ignored it. </p>
<p>After she delivered her son, it all got worse. She felt as if she was in a black hole of sadness. She often gave her son to her mother, thinking he was better off without her. It wasn’t until a year and a half later, when she came out of the depression on her own, that she realized that she had not been herself. </p>
<p>Judy is a composite figure, based on the thousands of women for whom we have cared for or met during our clinical work and research. Her story demonstrates the profound impact that depression can have on mothers and their children. </p>
<p>Having a baby can be extraordinarily challenging. Women are extremely vulnerable to emotional changes during pregnancy and the year after delivery. In fact, depression is <a href="https://www.ncbi.nlm.nih.gov/pubmed/26444130">the most common complication of pregnancy</a>. But women often have <a href="https://www.ncbi.nlm.nih.gov/pubmed/23194018">absolutely no idea they have depression</a>, nor do anyone in their circle of influence, including their medical providers.</p>
<p>We believe there’s a missed opportunity to address depression in obstetric and pediatric settings: settings in which women are seen often during pregnancy and the year after birth. Women like Judy often drown in their illness, without anyone ever speaking to them about the possibility of depression. How and why does the health care system let this happen? </p>
<h2>Untreated depression</h2>
<p>One in 7 women <a href="https://www.ncbi.nlm.nih.gov/pubmed/16260528">experience depression</a> during pregnancy and after birth. Depression negatively impacts mothers, children and families. It can affect <a href="https://www.ncbi.nlm.nih.gov/pubmed/2092111">birth outcomes</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/11391337">the way moms bond with their baby</a> and can affect <a href="https://www.ncbi.nlm.nih.gov/pubmed/18651886">children’s mental health</a> later in life.</p>
<p>When untreated, depression can also lead to tragic outcomes, including suicide or infanticide. In fact, <a href="https://www.ncbi.nlm.nih.gov/pubmed/15883651">suicide is the leading cause of death</a> among postpartum women with depression. </p>
<p>This illness is also costly. <a href="https://www.ncbi.nlm.nih.gov/pubmed/16260528">One case of untreated depression</a>
is estimated to cost over <a href="http://www.wilder.org/redirects/CostofUntreatedMaternalDepression.html">US$22,000 annually</a> per mother and baby pair.</p>
<p>Despite being a common illness with profound negative effects, most depression among pregnant and postpartum women goes unrecognized and untreated. Of the 4 million women who give birth in the U.S. every year, about 14 percent will experience depression. At least 80 percent <a href="https://www.ncbi.nlm.nih.gov/pubmed/26444130">will not generally get treatment</a>.</p>
<p>There’s historically been no system in place to detect depression or help women get care. But <a href="https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression">professional societies</a> and <a href="https://www.medicaid.gov/federal-policy-guidance/downloads/cib051116.pdf">policymakers</a> are starting to recommend screenings, while <a href="https://www.ncbi.nlm.nih.gov/pubmed/29553986">medical practices</a> are beginning to <a href="https://doi.org/10.1097/GRF.0000000000000360">integrate depression</a> into obstetric and pediatric care. </p>
<p>This is a great first step. However, screening is not enough. After screening, the health system must ensure women get appropriately diagnosed and treated. Unfortunately, <a href="https://doi.org/10.1080/02646838.2012.743000">many providers aren’t trained or equipped with the proper resources</a> to help women with depression, or <a href="https://doi.org/10.1007/s11126-014-9293-7">may be reluctant</a> to do so. </p>
<h2>MCPAP for Moms</h2>
<p>In response to this need, our team is working on integrating depression into obstetric care in our state. </p>
<p>Our <a href="https://www.ncbi.nlm.nih.gov/pubmed/27079616">Massachusetts Child Psychiatry Access Program for Moms</a>, launched in July 2014, helps front line medical providers screen for and treat depression and other mental health concerns among pregnant and postpartum women. </p>
<p>MCPAP for Moms provides training and toolkits for providers, as well as telephone and face-to-face psychiatric consultation. For example, Judy’s obstetric provider could call MCPAP for Moms and talk to a psychiatrist to get guidance on how to treat, and with consultation, decide on a treatment plan that would include therapy. MCPAP for Moms also offers resources directly to women with ongoing mental health care. </p>
<p>Every provider in Massachusetts can access our services free of charge. MCPAP for Moms is funded through the MA Department of Mental Health. It also offers <a href="https://www.statnews.com/2017/01/09/postpartum-depression-massachusetts/">access to mental health care</a> to pregnant and postpartum women in Massachusetts <a href="https://www.ncbi.nlm.nih.gov/pubmed/27079616">for less than $1 per month per woman</a>. We are now evaluating how the program has affected outcomes for the more than 4,000 patients directly served since launch. </p>
<p>Two other states, Washington and Wisconsin, are starting programs like MCPAP for Moms, and 17 others are seeking funding. Especially exciting, <a href="https://www.congress.gov/bill/115th-congress/house-bill/1625/text">next year’s federal budget</a> includes grant money for other states to establish such programs. We envision a health care system where all providers caring for pregnant and postpartum women are armed with the resources they need to support women with depression.</p><img src="https://counter.theconversation.com/content/94238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Moore Simas is Co-PI of a grant supported by the Centers for Disease Control and Prevention (CDC; Grant number: 1U01 DP006093) and Co-I on a grant supported by the National Institute of Health (R41 MH113381) for projects related to perinatal depression. Dr. Moore Simas is lead obstetric liaison of the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms), and thus receives a stipend from the Massachusetts Department of Mental Health via Beacon Health Options. Dr. Moore Simas is medical director of Lifeline4Moms, a program founded to provided technical assistance in support of others creating perinatal psychiatric access programs and integrating obstetric and perinatal mental health care. Dr. Moore Simas co-directs the American College of Obstetricians and Gynecologists’ Expert Work Group on Maternal Mental Health and was a member of the Council on Patient Safety in Women’s Health Care’s task force that created a Maternal Mental Health Patient Safety Bundle and is co-author on the associated commentary. Dr. Moore Simas has served on Physician Advisory Boards for Sage Therapeutics, has received speaking honoraria, and serves as a consultant on observational studies and a systematic review; additionally she has received compensation for reviewing a perinatal depression case for McGraw Hill.
</span></em></p><p class="fine-print"><em><span>Dr. Byatt has received salary and/or funding support from Massachusetts Department of Mental Health via the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms). She is also the statewide Medical Director of MCPAP for Moms. Dr. Moore Simas is the executive director of Lifeline4Moms, a program founded to provided technical assistance in support of others creating perinatal psychiatric access programs and integrating obstetric and perinatal mental health care. She has served on the Perinatal Depression Advisory Board for the Janssen Disease Interception Accelerator Program, the Medscape Steering Committee on Clinical Advances in Postpartum Depression, the Perinatal Depression Advisory Board for the Janssen Disease Interception Accelerator Program, Advisory Boards for Sage Therapeutics, and is a Council Member of the Gerson Lehrman Group. She has also received speaking honoraria from Sage Therapeutics. She receives funding from the CDC and the NIH. </span></em></p>Depression can have a profound impact on mothers and their children. But women often have no idea that they have depression – nor do their medical providers.Tiffany Moore Simas, Associate Professor of Obstetrics-Gynecology and Pediatrics, University of Massachusetts Medical SchoolNancy Byatt, Associate Professor of Psychiatry and Obstetrics & Gynecology, University of Massachusetts Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/478202015-12-02T11:05:25Z2015-12-02T11:05:25ZWhat clues does your dog's drool hold for human mental health?<figure><img src="https://images.theconversation.com/files/103945/original/image-20151201-26568-1ld7n8o.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">There goes some precious DNA....</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/graemebird/2478467142">Graeme Bird</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Dogs were the <a href="https://theconversation.com/new-dna-analysis-says-your-poochs-ancestors-were-central-asian-wolves-49271">first animals people domesticated</a>, long before the earliest human civilizations appeared. Today, tens of thousands of years later, dogs have an unusually close relationship with us. They share our homes and steal our hearts – and have even evolved <a href="http://barkpost.com/dogs-love-us-like-family/">to love us back</a>. Sadly, they also suffer from many of the same difficult-to-treat psychiatric and neurological diseases we do.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/103939/original/image-20151201-26582-1tcleck.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/103939/original/image-20151201-26582-1tcleck.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip" srcset="https://images.theconversation.com/files/103939/original/image-20151201-26582-1tcleck.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=733&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/103939/original/image-20151201-26582-1tcleck.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=733&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/103939/original/image-20151201-26582-1tcleck.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=733&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/103939/original/image-20151201-26582-1tcleck.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=921&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/103939/original/image-20151201-26582-1tcleck.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=921&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/103939/original/image-20151201-26582-1tcleck.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=921&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Beskow, in fine spirits.</span>
<span class="attribution"><span class="source">Elinor Karlsson</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>I learned this firsthand about six years ago, when my sister Adria adopted Beskow, a beautiful, boisterous, black and white mutt. Beskow became my constant companion on my morning runs along the Charles River. Her joy in running was obvious to everyone we passed, and she kept me going mile after mile. </p>
<p>When not running, though, Beskow suffered from constant anxiety that left her stressed and unhappy – on edge around other dogs and prone to aggressive behavior. Beskow had trouble even playing outdoors, since she was compelled to attend to every sound and movement. Working one-on-one with skilled behaviorists and trainers helped immensely, but poor Beskow still never seemed able to relax. Eventually, Adria combined the intensive training with medication, which finally seemed to give Beskow some relief. </p>
<p>Beskow’s personality – her intelligence, her focus and her anxiety – was shaped not only by her own life experiences, but by thousands of years of evolution. Have you ever known a dog who would retrieve the same ball over and over again, for hours on end? Or just wouldn’t stay out of the water? Or wasn’t interested in balls, or water, but just wanted to follow her nose? These dogs are the result of hundreds of generations of artificial selection by human beings. By favoring useful behaviors when breeding dogs, we made the genetic changes responsible more common in their gene pool.</p>
<p>When a particular genetic change rapidly rises in prevalence in a population, it leaves a “signature of selection” that we can detect by sequencing the DNA of <a href="http://genomesunzipped.org/2010/09/detecting-positive-natural-selection-from-genetic-data.php">many individuals from the population</a>. Essentially, around a selected gene, we find a region of the genome where one particular pattern of DNA – the variant linked to the favored version of the gene – is far more common than any of the alternative patterns. The stronger the selection, the bigger this region, and the easier it is to detect this signature of selection. </p>
<p>In dogs, genes shaping behaviors purposely bred by humans are marked with large signatures of selection. It’s a bit like evolution is shining a spotlight on parts of the dog genome and saying, “Look here for interesting stuff!” To figure out exactly how a particular gene influences a dog’s behavior or health, though, we need lots more information. </p>
<p>To try to unravel these connections, my colleagues and I are launching a new citizen science research project we’re calling <a href="http://darwinsdogs.org/">Darwin’s Dogs</a>. <a href="http://iaabc.org/">Together with animal behavior experts</a>, we’ve put together a series of short surveys about everything from diet (does your dog eat grass?) to behavior (is your dog a foot sitter?) to personality (is your dog aloof or friendly?). </p>
<p>Any dog can participate in <a href="http://darwinsdogs.org/">Darwin’s Dogs</a>, including purebred dogs, mixed breed dogs, and mutts of no particular breed – our study’s participants will be very genetically diverse. We’re combining <a href="http://doi.org/10.1016/j.cell.2013.09.006">new DNA sequencing technology</a>, which can give us much more genetic information from each dog, with powerful new <a href="http://doi.org/10.1038/nrg3382">analysis methods that can control for diverse ancestry</a>. By including all dogs, we hope to be able to do much larger studies, and home in quickly on the important genes and genetic variants. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/103941/original/image-20151201-26574-6ny0rs.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/103941/original/image-20151201-26574-6ny0rs.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/103941/original/image-20151201-26574-6ny0rs.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=399&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/103941/original/image-20151201-26574-6ny0rs.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=399&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/103941/original/image-20151201-26574-6ny0rs.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=399&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/103941/original/image-20151201-26574-6ny0rs.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=501&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/103941/original/image-20151201-26574-6ny0rs.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=501&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/103941/original/image-20151201-26574-6ny0rs.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=501&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A beagle considers making the saliva donation.</span>
<span class="attribution"><span class="source">Stephen Schaffner</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Once an owner has filled out the survey, there’s a second, crucial step. We send an easy-to-use kit to collect a small dog saliva sample we can use for DNA analysis. There’s no cost, and we’ll share any information we find.</p>
<p>Our plan is to combine the genetic data from many dogs and look for changes in DNA that correlate with particular behaviors. It won’t be easy to match up DNA with an obsession with tennis balls, for instance. Behavior is a complex trait that relies on many genes. Simple <a href="http://www.nature.com/scitable/topicpage/gregor-mendel-and-the-principles-of-inheritance-593">Mendelian traits</a>, like Beskow’s black and white coat, are controlled by a single gene which determines the observable characteristic. This kind of inherited trait is comparatively easy to map. Complex traits, on the other hand, may be shaped by tens or even hundreds of different genetic changes, each of which on its own only slightly alters the individual carrying it. </p>
<p>Adding to the complexity, environment often plays a big role. For example, Beskow may not have been as anxious if she’d lived with Adria from puppyhood, even though her genetics would be unchanged. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/103946/original/image-20151201-26546-hlyirx.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/103946/original/image-20151201-26546-hlyirx.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip" srcset="https://images.theconversation.com/files/103946/original/image-20151201-26546-hlyirx.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=648&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/103946/original/image-20151201-26546-hlyirx.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=648&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/103946/original/image-20151201-26546-hlyirx.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=648&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/103946/original/image-20151201-26546-hlyirx.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=814&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/103946/original/image-20151201-26546-hlyirx.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=814&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/103946/original/image-20151201-26546-hlyirx.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=814&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Darwin’s Dogs team member Jesse McClure extracts DNA from a sample.</span>
<span class="attribution"><span class="source">Elinor Karlsson</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>To succeed, we need a lot of dogs to sign up. Initially, we’re aiming to enroll 5,000 dogs. If successful, we’ll keep growing. With bigger sample sizes, we’ll be able to tackle even more complex biological puzzles. </p>
<p>This is a huge effort, but could offer huge rewards. By figuring out how a genetic change leads to a change in behavior, we can decipher neural pathways involved in psychiatric and neurological diseases <a href="http://doi.org/10.1016/S0278-5846(00)00104-4">shared between people and dogs</a>. We already know these include not just anxiety, but also <a href="http://www.nytimes.com/2011/12/02/us/more-military-dogs-show-signs-of-combat-stress.html">PTSD</a>, <a href="http://doi.org/10.1186/gb-2014-15-3-r25">OCD</a>, <a href="http://doi.org/10.1038/tp.2014.106">autism spectrum disorders</a>, <a href="http://doi.org/10.2460/javma.2001.219.467">phobias</a>, <a href="http://doi.org/10.1016/S0092-8674(00)81965-0">narcolepsia</a>, <a href="http://doi.org/10.1111/epi.12138">epilepsy</a>, <a href="http://doi.org/10.1016/0197-4580(95)02060-8">dementia and Alzheimer’s disease</a>.</p>
<p>Understanding the biology underlying a disease is the first step in developing more effective treatments – of both the canine and human variety. For example, <a href="http://doi.org/10.1016/S0092-8674(00)81965-0">genetic studies of narcolepsy in Doberman pinschers</a> found the gene mutation causing the disease – but only in this one dog population. Researching the gene’s function, though, led to critical new insights into the molecular biology of sleep, and, eventually, to <a href="http://dx.doi.org/10.2147/NSS.S56077">new treatment options for people</a> suffering from this debilitating disease. </p>
<p><a href="http://darwinsdogs.org">Darwin’s Dogs</a> is investigating normal canine behaviors as well as diseases. We hypothesize that finding the small genetic changes that led to complex behaviors, like retrieving, or even personality characteristics, like playfulness, will help us figure out how brains work. We need this mechanistic understanding to design new, safe and more effective therapies for psychiatric diseases. </p>
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<figcaption>
<span class="caption">Beskow with one of her loving family members.</span>
<span class="attribution"><span class="source">Adria Karlsson</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>And Beskow? Six years later, she is as wonderful as ever. While still anxious some of the time, the medication and training have paid off, and she enjoys her daily walks, training and playtime. She still gets very nervous around other dogs, but is a gentle, playful companion for my sister’s three young children.</p>
<p>We are now sequencing her genome. In the next few months, we should have our first glimpse into Beskow’s ancestry. We know she is a natural herder, so we’re curious to find out how much her genome matches up to herding breeds, and which genes are in that part of the genome.</p>
<p>Of course, we can’t figure out much from just one dog – if you are a dog owner, please <a href="http://darwinsdogs.org">enroll your dog today</a>!</p><img src="https://counter.theconversation.com/content/47820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elinor Karlsson receives funding from the NIH and the Worcester Foundation.</span></em></p>Researchers want your canine's DNA to help unravel the connections between genes and behavior – for dogs and human beings.Elinor Karlsson, Assistant Professor of Bioinformatics and Integrative Biology, University of Massachusetts Medical SchoolLicensed as Creative Commons – attribution, no derivatives.